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Archives of Osteoporosis

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01-12-2012 | Original Article

Phalangeal bone mineral density predicts incident fractures: a prospective cohort study on men and women—results from the Danish Health Examination Survey 2007–2008 (DANHES 2007–2008)

Authors: Teresa Friis-Holmberg, Kim Brixen, Katrine Hass Rubin, Morten Grønbæk, Mickael Bech

Published in: Archives of Osteoporosis | Issue 1-2/2012

Abstract

Summary

This prospective study investigates the use of phalangeal bone mineral density (BMD) in predicting fractures in a cohort (15,542) who underwent a BMD scan. In both women and men, a decrease in BMD was associated with an increased risk of fracture when adjusted for age and prevalent fractures.

Purpose

The aim of this study was to evaluate the ability of a compact and portable scanner using radiographic absorptiometry (RA) to predict major osteoporotic fractures.

Methods

This prospective study included a cohort of 15,542 men and women aged 18–95 years, who underwent a BMD scan in Danish Health Examination Survey 2007–2008. BMD at the middle phalanges of the second, third and fourth digits of the non-dominant hand was measured using RA (Alara MetriScan®). These data were merged with information on incident fractures retrieved from the Danish National Patient Registry comprising the International Classification of Diseases (ICD-10). Follow-up was 27–45 months. Major osteoporotic fractures (vertebral fractures, humerus fractures, forearm fractures and hip fractures) were used in the analyses. Fracture events were calculated as “persons with fracture” and evaluated using survival analysis.

Results

A total of 307 (1.98 %) of the participants had experienced a new fracture during follow-up. BMD was significantly lower in subjects with fracture (0.32 vs. 0.34 g/cm²; p < 0.001 adjusted for age, gender, prevalent fractures, height, weight and smoking). In both women and men, a 1 SD decrease in BMD (T score units) was associated with an increased risk of fracture when adjusted for age and prevalent fractures (women: HR = 1.39, CI 1.24–1.54, p < 0.001; men: HR = 1.47, CI 1.20–1.79, p < 0.001).

Conclusion

Phalangeal BMD as measured using RA predicts the incidence of major osteoporotic fractures.

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Johnell O, Kanis J (2005) Epidemiology of osteoporotic fractures. Osteoporos Int 16(Suppl 2):S3–S7PubMedCrossRef

Boot AM, de Ridder MA, van der Sluis IM, van Sloobe I, Krenning EP, Keizer-Schrama SM (2010) Peak bone mineral density, lean body mass and fractures. Bone 46:336–341PubMedCrossRef

Johnell O, Kanis JA, Oden A, Johansson H, De LC, Delmas P, Eisman JA, Fujiwara S, Kroger H, Mellstrom D, Meunier PJ, Melton LJ III, O’Neill T, Pols H, Reeve J, Silman A, Tenenhouse A (2005) Predictive value of BMD for hip and other fractures. J Bone Miner Res 20:1185–1194PubMedCrossRef

World Health Organisation (2007) Assessment of osteoporosis at the primary health care level. WHO Sientific Group, World Health Organisation, Brussel

Blake GM, Fogelman I (2009) The clinical role of dual energy X-ray absorptiometry. Eur J Radiol 71:406–414PubMedCrossRef

Rejnmark L, Abrahamsen B, Ejersted C, Hyldstrup L, Jensen J, Madsen OR, Mosekilde L, Schwarz P, Vestergaard P, Langdahl B (2009) Vejledning til udredning og behandling af osteoporose [Guidance for diagnosing and treatment of osteoporosis]. Dansk Knoglemedicinsk Selskab [Danish Bonemedical Society], Denmark

Frost M, Gudex C, Rubin KH, Brixen K, Abrahamsen B (2012) Pattern of use of DXA scans in men: a cross-sectional, population-based study. Osteoporos Int 23:183–191PubMedCrossRef

Rubin KH, Abrahamsen B, Hermann AP, Bech M, Gram J, Brixen K (2011) Prevalence of risk factors for fractures and use of DXA scanning in Danish women. A regional population-based study. Osteoporos Int 22:1401–1409PubMedCrossRef

Vestergaard P, Rejnmark L, Mosekilde L (2005) Osteoporosis is markedly underdiagnosed: a nationwide study from Denmark. Osteoporos Int 16:134–141PubMedCrossRef

10.

Curtis JR, Laster A, Becker DJ, Carbone L, Gary LC, Kilgore ML, Matthews RS, Morrisey MA, Saag KG, Tanner SB, Delzell E (2009) The geographic availability and associated utilization of dual-energy X-ray absorptiometry (DXA) testing among older persons in the United States. Osteoporos Int 20:1553–1561PubMedCrossRef

11.

Stone KL, Seeley DG, Lui LY, Cauley JA, Ensrud K, Browner WS, Nevitt MC, Cummings SR (2003) BMD at multiple sites and risk of fracture of multiple types: long-term results from the Study of Osteoporotic Fractures. J Bone Miner Res 18:1947–1954PubMedCrossRef

12.

Gluer CC, Eastell R, Reid DM, Felsenberg D, Roux C, Barkmann R, Timm W, Blenk T, Armbrecht G, Stewart A, Clowes J, Thomasius FE, Kolta S (2004) Association of five quantitative ultrasound devices and bone densitometry with osteoporotic vertebral fractures in a population-based sample: the OPUS study. J Bone Miner Res 19:782–793PubMedCrossRef

13.

Siris ES, Miller PD, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA, Berger ML, Santora AC, Sherwood LM (2001) Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the National Osteoporosis Risk Assessment. JAMA 286:2815–2822PubMedCrossRef

14.

Duppe H, Gardsell P, Nilsson B, Johnell O (1997) A single bone density measurement can predict fractures over 25 years. Calcif Tissue Int 60:171–174PubMedCrossRef

15.

Huang C, Ross PD, Yates AJ, Walker RE, Imose K, Emi K, Wasnich RD (1998) Prediction of fracture risk by radiographic absorptiometry and quantitative ultrasound: a prospective study. Calcif Tissue Int 63:380–384PubMedCrossRef

16.

Miller PD, Siris ES, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA, Chen YT, Berger ML, Santora AC, Sherwood LM (2002) Prediction of fracture risk in postmenopausal white women with peripheral bone densitometry: evidence from the National Osteoporosis Risk Assessment. J Bone Miner Res 17:2222–2230PubMedCrossRef

17.

Mussolino ME, Looker AC, Madans JH, Edelstein D, Walker RE, Lydick E, Epstein RS, Yates AJ (1997) Phalangeal bone density and hip fracture risk. Arch Intern Med 157:433–438PubMedCrossRef

18.

Ross P, Huang C, Davis J, Imose K, Yates J, Vogel J, Wasnich R (1995) Predicting vertebral deformity using bone densitometry at various skeletal sites and calcaneus ultrasound. Bone 16:325–332PubMedCrossRef

19.

Ekman A, Michaelsson K, Petren-Mallmin M, Ljunghall S, Mallmin H (2002) Dual X-ray absorptiometry of hip, heel ultrasound, and densitometry of fingers can discriminate male patients with hip fracture from control subjects: a comparison of four different methods. J Clin Densitom 5:79–85PubMedCrossRef

20.

Ohtsuka M, Michaeli D, Wasnich RD (2002) Relationship between phalangeal bone density and risk of vertebral fracture. J Clin Densitom 5:11–15PubMedCrossRef

21.

Saleh MM, Jorgensen HL, Lauritzen JB (2002) Odds ratios for hip- and lower forearm fracture using peripheral bone densitometry; a case–control study of postmenopausal women. Clin Physiol Funct Imaging 22:58–63PubMedCrossRef

22.

Marshall D, Johnell O, Wedel H (1996) Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 312:1254–1259PubMedCrossRef

23.

Eriksen L, Gronbaek M, Helge JW, Tolstrup JS, Curtis T (2011) The Danish Health Examination Survey 2007–2008 (DANHES 2007–2008). Scand J Public Health 39:203–211PubMedCrossRef

24.

World Health Organisation (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: Report of the WHO study group, 843rd edn, WHO technical report series. World Health Organisation, Geneva

25.

Hansen SJ, Nielsen MM, Ryg J, Wraae K, Andersen M, Brixen K (2009) Radiographic absorptiometry as a screening tool in male osteoporosis: results from the Odense Androgen Study. Acta Radiol 50:658–663PubMedCrossRef

26.

Thygesen LC, Daasnes C, Thaulow I, Bronnum-Hansen H (2011) Introduction to Danish (nationwide) registers on health and social issues: structure, access, legislation, and archiving. Scand J Public Health 39:12–16PubMedCrossRef

27.

Lynge E, Sandegaard JL, Rebolj M (2011) The Danish National Patient Register. Scand J Public Health 39:30–33PubMedCrossRef

28.

Ryg J, Rejnmark L, Overgaard S, Brixen K, Vestergaard P (2009) Hip fracture patients at risk of second hip fracture: a nationwide population-based cohort study of 169,145 cases during 1977–2001. J Bone Miner Res 24:1299–1307PubMedCrossRef

29.

Kanis JA, Johansson H, Oden A, McCloskey EV (2009) Assessment of fracture risk. Eur J Radiol 71:392–397PubMedCrossRef

30.

Kleinbaum DG, Klein M (2005) The Cox proportional hazards model and its characteristics. In: Kleinbaum DG, Klein M (eds) Survival analysis. A self-learning text, 3rd edn. Springer, New York, pp 97–160

31.

Seeley DG, Browner WS, Nevitt MC, Genant HK, Scott JC, Cummings SR (1991) Which fractures are associated with low appendicular bone mass in elderly women? The Study of Osteoporotic Fractures Research Group. Ann Intern Med 115:837–842PubMed

32.

Versluis RG, Petri H, Vismans FJ, van de Ven CM, Springer MP, Papapoulos SE (2000) The relationship between phalangeal bone density and vertebral deformities. Calcif Tissue Int 66:1–4PubMedCrossRef

33.

Mosbech J, Jorgensen J, Madsen M, Rostgaard K, Thornberg K, Poulsen TD (1995) The national patient registry. Evaluation of data quality. Ugeskr Laeger 157:3741–3745PubMed

34.

Vestergaard P, Mosekilde L (2002) Fracture risk in patients with celiac disease, Crohn’s disease, and ulcerative colitis: a nationwide follow-up study of 16,416 patients in Denmark. Am J Epidemiol 156:1–10PubMedCrossRef

35.

Cummings SR, Kelsey JL, Nevitt MC, O’Dowd KJ (1985) Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev 7:178–208PubMed

36.

Faulkner KG, von Steeten E, Miller P (1999) Discordance in patient classification using T-scores. J Clin Densitom 2:343–350PubMedCrossRef

37.

Faulkner KG, Orwoll E (2002) Implications in the use of T-scores for the diagnosis of osteoporosis in men. J Clin Densitom 5:87–93PubMedCrossRef

38.

Christensen AI, Severin M, Eriksen L, Toftager M, Zachariassen A, Ekholm O, Tolstrup JS, Grønbæk M, Curtis T (2009) KRAM-undersøgelsen i tal og billeder [The KRAM-study in numbers and pictures]. The Danish Ministry of Health and Prevention and the. TrygFoundation, Copenhagen

39.

Statistic Denmark (2009) StatBank Denmark http://www.statbank.dk/statbank5a/default.asp?w=1280 Accessed 5 Jun 2012

40.

Ekholm O, Kjøller M, Davidsen M, Hesse U, Eriksen L, Christensen AI, Grønbæk M (2006) Sundhed og Sygelighed i Danmark 2005 og udviklingen siden 1987 [Health and morbidity in Denmark 2005]. National Institute of Public Health, Copenhagen

41.

Brennan SL, Pasco JA, Urquhart DM, Oldenburg B, Hanna F, Wluka AE (2009) The association between socioeconomic status and osteoporotic fracture in population-based adults: a systematic review. Osteoporos Int 20:1487–1497PubMedCrossRef

Title: Phalangeal bone mineral density predicts incident fractures: a prospective cohort study on men and women—results from the Danish Health Examination Survey 2007–2008 (DANHES 2007–2008)
Authors: Teresa Friis-Holmberg
Kim Brixen
Katrine Hass Rubin
Morten Grønbæk
Mickael Bech
Publication date: 01-12-2012
Publisher: Springer-Verlag
Published in: Archives of Osteoporosis / Issue 1-2/2012
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI: https://doi.org/10.1007/s11657-012-0111-2

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Phalangeal bone mineral density predicts incident fractures: a prospective cohort study on men and women—results from the Danish Health Examination Survey 2007–2008 (DANHES 2007–2008)

Abstract

Summary

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Summary

Purpose

Methods

Results

Conclusion

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